Provider Demographics
NPI:1649369877
Name:BROWN, CHANDRA E (CERTIFIED SOCIAL WOR)
Entity type:Individual
Prefix:MS
First Name:CHANDRA
Middle Name:E
Last Name:BROWN
Suffix:
Gender:F
Credentials:CERTIFIED SOCIAL WOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MEDICAL GROUP
Mailing Address - Street 2:BLDG 1400 208 W CASABLANCA CANNON AFB
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88103-5014
Mailing Address - Country:US
Mailing Address - Phone:505-784-6608
Mailing Address - Fax:505-784-6028
Practice Address - Street 1:27 MEDICAL GROUP
Practice Address - Street 2:BLDG 1400 208 W CASABLANCA CANNON AFB
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88103-5014
Practice Address - Country:US
Practice Address - Phone:505-784-6608
Practice Address - Fax:505-784-6028
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801083261104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN